Category Archives: Addictive Behaviors

Anyone who has been in the addiction treatment field for the past couple of decades has seen how technological advances can influence the delivery of treatment. Our experience is that like most things, there is an upside and a downside to all of it. On the one hand, application-filled mobile devices have allowed people in recovery to gain access to 12-step and other mutual help meetings, connect with others in recovery and even manage sobriety day counts. On the other hand, instant access to the internet can unleash a torrent of relapse behaviors among addicts who are trying to remain sober. For many in recovery behaviors like obtaining illicit substances and finding sexual partners are only clicks away on a mobile device or laptop.

A frequent intervention for people re-entering the community used to be to get rid of cell phones and /or delete nefarious contacts from the directory so that obtaining drugs would be harder to do. Not a 100% guarantee against relapse, the action of purging contacts was itself a way to communicate one’s dedication to recovery. Unfortunately, now that we have “The Cloud” getting rid of addiction-related contacts is not so easy. In fact, it is practically impossible. No cell phone? No problem, just get a new phone and sign in with a google account and all of the old contacts magically appear. Of course it is possible to go a level deeper and delete contacts from gmail and other accounts, and this is what must be done if those in early recovery want to rid those influences from their social networks.

No other system is entrenched in the idea of drug addiction being characterlogical then sports. Any issue with drugs is pegged with the cliches of addicts “waste of talent” “cheater” “undeserving of their talent” “a disgrace to kids”. What is never heard in the alcohol financed sports world is “disease” “Mental health issue” or “Pathology”. There was a time when Ryan Leaf was thought to be a once in a decade type quarterback, one of the greats. What could have happened if the NCAA and NFL had a comprehensive policy and program to deal with issues before they reach a crisis level. As it is, Ryan Leaf is another cautionary tale of lost potential working at a car dealership of maybe a high school coach if he can stabilize. The drug policy in professional sports is arcane and rooted in punishment. That is bad policy rooted in shame and the result is stories like Ryan Leaf’s.

Robin Williams is dead. Is this a shock? No. Is it a tragedy? Absolutely. Without knowing any of the details about his psychiatric treatment, from a purely statistical standpoint Mr. Williams had a number of risk factors that are often identified ‘after the fact’ in suicidal patients – he suffered from a serious mood disorder, addiction to drugs and alcohol and he had open-heart surgery which is well-known to be associated with severe depression even years later. Now we are finding out that he suffered from early stage Parkinson’s Disease. To the general public his comedic veneer and successful acting career probably made it seem like he was impervious to the ravages of depression and addiction – clearly a falsehood.
It’s fascinating that in the wake of his death, one of the immediate reactions among pundits and medical professionals is that “we hope that Mr. Williams’ death brings to light issues about depression and addiction and helps end stigma so that people come forth and get help.” The implication is that those who are too ashamed to ask for help for depression and/or addiction suffer the consequences. While we are all in support of ending the stigma associated with mental illness and addiction, the fact is that Robin Williams was totally open about both of his struggles not only with depression but also addiction. Without knowing any of the details about his illness or his treatment, it is difficult, if not impossible to speculate about exactly what happened to him. Yet it is possible that he survived as long as he did because he was open about his problems and received a good deal of help for them. The sad fact is, that people who have multiple risk factors for early death often die young. This is true for those suffering from illnesses like diabetes, cancer and heart disease, and it is also true for those who suffer from certain mental illnesses – primarily mood disorders and psychotic disorders – and certainly addiction.
While the field of psychiatry has its limits, one thing we know well is that the risks and consequences of major mental illness are real and severe, and are clearly exacerbated by the use of drugs and alcohol. We know that Robin Williams suffered from a mood disorder, either Bipolar Disorder or Unipolar Depression complicated by addiction – a combination that is possibly the most catastrophic of all the major mental illnesses. Whether or not he actually suffered from Bipolar Disorder or just “Unipolar” Depression is irrelevant – we will probably never know the exact details of his psychiatric treatment.
Bipolar disorder, otherwise known as Manic Depression is a disease of the brain characterized by major shifts in mood that vacillate between high energy manic states, periods of relative calm, and very low mood depressive and often suicidal feelings – it is a major mental illness that is almost entirely treated with medication. People who suffer from Unipolar Depression experience periods of severe depression, sometimes resulting in suicidal thinking that lasts for days to weeks or even months, followed by periods of relatively normal mood. The good news is this: with medication, therapy and avoidance of drugs and alcohol, many patients who suffer from both Bipolar Disorder and Unipolar Depression can keep the symptoms check and live a relatively stable life. The bad news: Many patients who suffer from these mood disorders are at a heightened risk of a number of tragic problems including suicidal behavior, substance abuse, violence, job loss, relationship problems and serious health issues.
The statistics are impressive: About 2 million Americans suffer from bipolar disorder with an equal distribution between men and women. Depression probably affects upwards of 20% of Americans at some point in their lives. In 2012, 16 million adults over 18 (6.9% of the population) suffered at least one Major Depressive Episode in the prior year. Up to 50% of patients who suffer from Bipolar Disorder make a suicide attempt at some point in their lives and about 10-15% succeed in killing themselves. Life stress, addiction, broken relationships, social isolation, physical health problems and medication non-compliance all increase the risk of suicide.
One of the major challenges patients suffering with Bipolar Disorder face is the need to continually take “mood stabilizing” medications despite that fact that they can cause feelings of “dullness”, and emotional blunting. They even need to take the medication during times of “euthymia” (normal mood). Many patients complain that “normal” living feels like depression to them – they enjoy and often thrive on the highs associated with manic behavior – which is often a source of creative and/or athletic genius. Many Bipolar patients stop medication despite their doctors telling them that they need to continue taking them, even when they are stable and doing well. They like being manic. Further complicating the picture is the fact that for many people, manic episodes, while ominous, can be a source of major creative and intellectual inspiration.
The fact is, Mood Disorders are chronic, relapsing, remitting diseases of the brain that require on-going treatment and monitoring by mental health professionals. Studies clearly show that every time a person suffers from an episode of mania or depression, the brain becomes somewhat de-stabilized which results in a more insidious course of the illness. That is, future episodes last longer, are more severe and come more frequently – thus the recommendation to treat these illnesses early and aggressively with medication, psychotherapy and cognitive behavioral therapy.
A final point about suicide: despite decades of serious research and study, predicting suicide, and other violent behaviors remains a difficult task since it is a relatively rare, though tragic problem. The problem is that while people who commit suicide almost always demonstrate a number of risk factors, the overwhelming majority of people with the same risk factors as Robin Williams, will never attempt or commit suicide or other violent behaviors.
We need to take depression, addiction and all mental illness seriously as diseases that require treatment. The behaviors associated with these illnesses are not simply “bad choices”, but manifestations of chronic brain problems that we are still trying to understand.

Is it real? Can people actually be addicted to video games? Where does the idea of being “addicted” end, and is it ever used just as an excuse for any bad behavior? Internationally, “I have a disease” seems to have become a modern day way to relieve people of responsibility. Could the US see a similar problem?

Regarding video games, addictive mechanisms are certainly in play, and technically people can be addicted to anything. Current research focuses on the reward system in the brain. The cultural aspects of it are less clear. We have seen trends in the culture where proclaiming oneself an addict is in fashion, the card to be pulled when someone asks for accountability. The treatment plan for a video game addict may in fact be more than the “off switch” and there have been special programs to treat this behavior. The truth is, though we don’t like to admit it, these addictive behaviors are a “spectrum” phenomenon that range from mild to severe. We all have tendencies, the question is whether or not there is functional impairment, that impacts our lives to the point where we need to do something about it. The policy in South Korea seems extreme. Rebound Brooklyn treats a wide swath of addictive behaviors as well as addiction to substances. Often times there are psychiatric underpinnings of these behaviors. Our program, with it’s strong emphasis on psychiatric issues, can help. #video game addiction.